Provider Demographics
NPI:1487826475
Name:GUTHRIE, JACQUELINE ANN-MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANN-MARIE
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:706-234-4418
Mailing Address - Fax:706-234-9320
Practice Address - Street 1:1000 JOHNSON FERRY RD STE A115
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068
Practice Address - Country:US
Practice Address - Phone:404-367-2085
Practice Address - Fax:404-367-2085
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008205225100000X
GA8205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I650128Medicare PIN